CritCareCardio

Adham M Karim, MD @CaseUHMed @Kentucky_Cards @UChicagoMed alum- All tweets are my own

[CritCareCardio @CritCareCardio]

50’s M w DM HTN HLD new fatigue w exertion, tobacco user, lung CT w incidental CAC. Stress test ordered d/t symptoms/ risk factors.
Good ole American Healthcare
Stress -> denied order a CAC
CAC -> denied order stress echo
Stress echo -> denied order a CAC

[CritCareCardio @CritCareCardio]

Excellent and insightful write up. Curious to see what long term outcomes will be with increased DCB adoption

[Annette Maznyczka @AMaznyczka]

Is the Cx ostium still the Achilles heel of LM bifurcation PCI?

Our analysis from the EBC MAIN trial is now published in @CircIntv

The Cx ostium was the commonest site requiring revascularization after LM bifurcation PCI, irrespective of whether one or two stents had been deployed.

https://t.co/q14om6LHr4

@Ryvetsprog @GoranEBC @BURZOTTA_F @dmylotte @jacockburn @MPAOSS @alaide_chief @mmlindsay71 @MohanedEgred @h_evald @arunothayaraj @mmamas1973 @BifurcationClub #bifurcation #PCI

[Sandeep Nathan, MD, MSc @SandeepNathanMD]

Last chance to register for @SCAI FIRST Chicago Thurs April 17, 2025. Pls join @AdhirShroff & I for 5 great cases presented by #InterventionalCardiology fellows from around #ChiTown. (Come for the cases/stay for the colorful commentary :) #CardioTwitter
https://t.co/g7EaG6rodt

[AHA Science @AHAScience]

The 2025 ACS guideline synthesizes new evidence since the 2013 STEMI and 2014 NSTEMI guidelines and the 2015 focused update on primary PCI in STEMI.

This guideline was developed with @ACCInTouch in collaboration with and endorsed by @EmergencyDocs @NAEMSP @SCAI

[CritCareCardio @CritCareCardio]

@drjohnm @djc795 CCTA can be superior in that it offers a definitive answer. Not just affirming or refuting the presence of CAD, but also quantifying the extent. It is up to us as clinicians to decide when to halt the testing cascade though.

[Sandeep Nathan, MD, MSc @SandeepNathanMD]

80 yo pt w/HTN, DM, HF recovered EF (45-50%) CAD, NASH & diverticular bleed 1 yr ago presents w crushing CP, HR 40, BP 90/50/63 MAP. DAPT+UFH in ED. ECG c/w inf STEMI; angio & still images👇🏽. What’s your preferred approach #CardioTwitter? #MedTwitter

[CritCareCardio @CritCareCardio]

@drjohnm The only thing to be skeptical of is the thought that a single lab or imaging test results should dictate the entirety of a patient’s care for the rest of their life - CAC of 0 has a very useful negative predictive value, but that NPV is not 100%

[Pradeep Natarajan @pnatarajanmd]

Great option for those taking CV meds! Great mission! @mcuban

Lisinopril $3.60 (retail $24)
Losartan $4.50 ($27.90)
Valsartan $9.90 ($69)
Clopidogrel $5.70 ($60.30)
Furosemide $4.20 ($8.70)
Atorvastatin $3.60 ($55.08)
Spironolactone $4.20 ($14.40)
Metformin $3.90 ($20.10)

[CritCareCardio @CritCareCardio]

@RickyHansra @CardioCrit @PittCardiology @PittCCM @CardioNerds @PACCM_fellows @PHAssociation Wow, the last time I saw these pressures in a PA it didn’t end well for the patient 😞

Great ECG to cath correlate!

[CritCareCardio @CritCareCardio]

@DavidLBrownMD I think CCTA is a tool, and its intent depends on the person ordering the test.

However, if I’m getting a CCTA for any reason, and the FFR can be made available without subjecting the patient to increased risk, what’s the argument against it?

[CritCareCardio @CritCareCardio]

@DavidLBrownMD I agree that initial treatment is the same, but you just stated its value. Far superior to stress testing in terms of less false positive rate, and I can’t think of a better way to rule out left main without subjecting someone to the risks of a diagnostic cath.

[CritCareCardio @CritCareCardio]

@mirvatalasnag @sbrugaletta @alaide_chief @Allison_Dupont @drptca @thiele_holger @KardiologieHH @kaschenke @MusaSharkawiMD @haithamahmedmd @AbosalemElsayed @ahmsolmd @A_N_Mahmoud_MD @mw_sherwood @DrShereen_ @dcscant Wow very nice, glad she recovered👏

Do you happen to have the RHC numbers?

Did you end up getting CMR? Incredibly curious what LGE looks like.

[CritCareCardio @CritCareCardio]

@mirvatalasnag @sbrugaletta @alaide_chief @Allison_Dupont @drptca @thiele_holger @KardiologieHH @kaschenke @MusaSharkawiMD @haithamahmedmd @AbosalemElsayed @ahmsolmd @A_N_Mahmoud_MD @mw_sherwood @DrShereen_ @dcscant I’m concerned for an inflammatory/infiltrators process. Both RV and LV look thickened…what was the PAPI from the RHC? If low, I’d be thinking ECMO, steroids, and urgent transplant work up for biV failure in setting of severe myocarditis.

[Gregg Fonarow MD @gcfmd]

Placing HFrEF in the context of other medical conditions may make the “extreme high-risk” and “very extreme high-risk” nature of HFrEF more readily apparent; lead to greater prioritization of HF prevention and treatment efforts

Contextualizing Risk in HF https://t.co/kIhOInNBuv

[CritCareCardio @CritCareCardio]

PRO: you don’t have to wake your interventionalist 😁😁

[AHA Acute CV Care @AHA_AcuteCVCare]

Finally, is CCTA the ideal test for patients with suspected NSTEACS?

(Due to tech issues, we only have the Con argument recorded – so feel free to put the Pro arguments in the replies!)

Pro - Dr. Klaus Kofoed
Con - @mirvatalasnag

[CritCareCardio @CritCareCardio]

@mirvatalasnag @soumd @smithECGBlog @PendellM @DavidLBrownMD @AntoniousAttall @mmamas1973 @escardio Thank you for your expert input Dr. Alasnag!
I view Wellen’s as a high risk marker; in this scenario, patient ended up getting dosed with contrast twice - CCT + then Cath
#imagefirst is my mantra but like you, I’d prefer to go straight to cath in this scenario